本文關(guān)鍵詞： 產(chǎn)前超聲 胎兒畸形 解剖結(jié)構(gòu) 高危因素　出處：《江蘇大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探究系統(tǒng)性產(chǎn)前超聲篩查胎兒解剖結(jié)構(gòu)異常的價值分析及產(chǎn)前超聲篩查胎兒畸形漏誤診原因的分析。方法:1.對2014年3月至2017年3月在我院超聲科進行系統(tǒng)性產(chǎn)前超聲檢查并在我院生產(chǎn)的孕婦7160例作為研究資料,通過不同孕周的超聲檢查,記錄正確診斷胎兒畸形時的孕周、類別和例數(shù),并按照系統(tǒng)解剖分類。分析畸形胎兒在不同孕周的比例關(guān)系。計算超聲篩查胎兒結(jié)構(gòu)畸形的靈敏度、特異性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比、陰性似然比。2.在7160例畸形中,分析超聲準確診斷胎兒畸形的孕婦相關(guān)高危因素,高危因素與無高危因素的孕婦其胎兒畸形運用卡方檢驗對比分析得出結(jié)果。3.在7160例孕婦中,通過超聲診斷結(jié)果與引產(chǎn)后及臨床分娩結(jié)果進行對比統(tǒng)計,運用卡方檢驗得出結(jié)果,隨訪漏誤診病理,對其原因進行詳細分析。結(jié)果:1.本組研究顯示精確檢出胎兒畸形264例,檢出率為3.69%。按器官系統(tǒng)不同排前5名:心血管系統(tǒng)、中樞神經(jīng)系統(tǒng)、泌尿系統(tǒng)、顏面部及頸部、骨骼肌肉系統(tǒng)及前腹壁畸形并列第5名。按詳細畸形病種區(qū)分前5名:唇腭裂、無腦兒/露腦兒、多囊腎、腦積水、心內(nèi)膜墊缺失及腎積水并列第五。2.孕早期及中孕早期篩查檢出畸形以神經(jīng)管缺陷(無腦兒、露腦兒)為主;孕中期結(jié)構(gòu)畸形篩查覆蓋各個臟器器官,以心血管發(fā)育異常最多見,其次是泌尿系統(tǒng)及神經(jīng)管缺陷常見;晚孕期胎兒心血管發(fā)育異常為主,其次是顏面部及頸部畸形和泌尿系統(tǒng)畸形并列第二。3.產(chǎn)前超聲診斷的符合率99.59%,靈敏度91.35%,特異性99.94%,陽性預(yù)測值97.78%,陰性預(yù)測值99.67%,陽性似然比1522.5,陰性似然比0.0865。4.胎兒畸形的發(fā)生率與孕婦的病毒感染、高齡、孕期接觸有害物質(zhì)及服用可致畸的藥物具有明顯相關(guān)性。5.通過隨訪超聲漏誤診結(jié)果:23例漏診病例,6例誤診病例,其中2例心臟畸形診斷錯誤,4例正常胎兒診斷為輕微畸形。超聲診斷結(jié)果與引產(chǎn)后或臨床分娩結(jié)果進行對比分析,P0.05,說明雖然超聲診斷出現(xiàn)漏誤診情況,但是超聲在診斷胎兒畸形應(yīng)用上依舊具有重要的意義。結(jié)論:產(chǎn)前系統(tǒng)性超聲篩查胎兒解剖結(jié)構(gòu)異常具有非常重要的價值,雖然超聲不能篩查出所有的疾病,但是它的安全性能、可重復(fù)性、無創(chuàng)性等都使得產(chǎn)前超聲已成為一種絕不能缺失的檢查方式。
[Abstract]:Objective: to explore the value of systematic prenatal ultrasound screening fetal anatomical structural abnormalities and the causes of misdiagnosis of fetal malformation by prenatal ultrasound screening. Methods: 1. Systematic analysis of ultrasound department of our hospital from March 2014 to March 2017. A total of 7160 pregnant women born in our hospital were examined by prenatal ultrasound as the data of the study. By ultrasonic examination of different gestational weeks, the gestational weeks, types and cases of fetal malformations were recorded, and the proportion of malformed fetuses in different gestational weeks was analyzed according to systematic anatomical classification. The sensitivity of ultrasonic screening of fetal structural deformities was calculated. Specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio. In 7160 cases of pregnant women, the results of ultrasound diagnosis were compared with the results of induced labor and clinical delivery, and the results were obtained by chi-square test. The causes of misdiagnosis were analyzed in detail. Results: in this study, 264 cases of fetal malformation were accurately detected, and the detection rate was 3.69. According to the organ system, the top 5 were: cardiovascular system, central nervous system, urinary system, and so on. Facial and cervical, musculoskeletal and anterior abdominal wall deformities were ranked 5th. According to detailed deformities, the top 5 were cleft lip and palate, anencephaly / exposed brain, polycystic kidney, hydrocephalus, Absence of endocardial cushion and hydronephrosis were 5th. 2. Neural tube defects (anencephaly, exposed brain) were mainly detected in early pregnancy and early pregnancy, the second trimester of pregnancy covered various organs and organs, and cardiovascular abnormalities were the most common. Secondly, urinary system and neural tube defects were common, and abnormal cardiovascular development of fetus during late pregnancy was the most common. The conformance rate of prenatal ultrasound diagnosis was 99.59, sensitivity 91.35, specificity 99.94, positive predictive value 97.78 and negative predictive value 99.677.The positive likelihood ratio was 1522.5, the negative likelihood ratio was 0.0865.4. The incidence of viral infection in pregnant women, In old age, exposure to harmful substances during pregnancy and teratogenic drugs were significantly correlated. 5. The misdiagnosis of 23 missed cases was found in 6 cases. Two cases of cardiac malformation were diagnosed as mild malformations in 4 cases of normal fetuses. The results of ultrasound diagnosis were compared with the results of induced labor or clinical delivery (P 0.05). However, ultrasound is still of great significance in the diagnosis of fetal malformations. Conclusion: prenatal systematic ultrasound screening of fetal anatomical abnormalities is of great value, although ultrasound can not screen all diseases. However, its safety, repeatability, noninvasive, etc., make prenatal ultrasound an indispensable examination method.
【學位授予單位】：江蘇大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R714.5

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